Optimum time to take oral sedation?

[bella127]

Hi there,

I'm trying the whole oral sedation route at the moment.

I've been given 10mg diazepam tablets, and the instructions were to take 10mg the night before, 10mg when I wake up, and 10mg before the appointment.

I did that - and another 10mg in the waiting room a I was still on the verge of a breakdown. It just about - and I mean only just about - took the very slightest edge off.

I have to go back in on Thursday for two fillings. The panic and nausea have already started creeping in.

My main question, is what is the optimum time to take the tablets to feel the effects when I need them most? I'm not going to bother with the night before tablet (I just cry myself to sleep ), and have to go to work before the procedure so probably won't take one when I wake up (7.30am, work at 8.45am, will leave work at 10.20am to get there for my appointment that is 10.50am).

I think I'll end up taking 3 tablets, so 30mg. When would be the best time to take them? How long does it take for the effects to be at their strongest?

Thank you..

 

[comfortdentist]

In the USA serial doses like you described is not permitted in most states unless the doctor has a sedation permit. In general Valium(Diazapam) has a very long 1/2 life so I don't consider it a great drug for sedation. The details you will have to work out with your dentist. Depending on where you are you might have other options.

 

[bella127]

I'm in the UK. It was the dentist herself that prescribed the diazepam for me.

I would much prefer IV sedation, which I had previously (about 6 years ago, different practice, different part of the country) but have been encouraged to try and get through with the diazepam to begin "conquering" my phobia.

 

[Pianimo]

I'm in the UK. It was the dentist herself that prescribed the diazepam for me.

I would much prefer IV sedation, which I had previously (about 6 years ago, different practice, different part of the country) but have been encouraged to try and get through with the diazepam to begin "conquering" my phobia.

I have to say, IMO if you'd prefer IV sedation, then you should be able to have it. I understand where your dentist is coming from, and I'm certain she has your best interests in mind, but ultimately, unless there are medical contraindications, it should be the patient's choice.

I feel strongly about this because I personally don't agree with the belief that IV sedation prevents people from dealing with their fears. Firstly, I know from my own experience that positive dental appointments done under IV sedationn CAN and DO help someone be less nervous about and more able to cope with future appointments without sedation. The first thing I let my old dentist do to me unsedated was replace a temporary filling, which may seem like a little thing to people, but even that would have felt impossible to me until I'd built up a relationship of trust and a gained a few positive dental experiences with her - which were all either treatment under IV sedation, or just talking appointments.

Secondly, my goal is not necessarily the same as other people's, or a dentist's goal for me. In other words, having treatment unsedated is not my goal! In addition to anxiety, I have a mouth phobia and strong gag reflex, and hate having things in my mouth. A year and a half ago, I couldn't imagine even thinking about a dental appointment without hating the idea, feeling terrified, and not getting so far as booking, let alone going. Pain forced my hand...and discovering treatment under IV sedation introduced me to a world where dental appointments didn't have to be a "GET-ME-OUT-OF-HERE-NOW!" experience from start to finish. Ok, I still get (very!) nervous before appointments, but I book them, I turn up, and I KNOW I can get through them. I don't like going, but I don't totally dread it or avoid it any more.

And this is enough for me. I don't feel that forcing myself to go through treatment unsedated is worth it - and that's my choice. I'm happy knowing I'll possibly always have actual treatment (e.g. filling, RCT, exctraction) under IV sedation (check-ups, hygiene and short/'little' stuff unsedated). For me, 'conquering' my phobia is not about becoming like the non-phobic people, but rather about not letting it control me any more. IV sedation HELPS me in that goal; it doesn't hinder me. If I've found a way to make going to the dentist something I can cope with, even something 'ok' - why on earth wouldn't I want to use it?!

Oh dear, sorry, you've got me on a hobby horse there! And, I haven't even answered your question! I guess I just wanted to say that you shouldn't feel your dentist's way is the only way - you need to do what's right for you. We're all different, and for some people (possibly including you!) what your dentist is doing would be ideal. I'm always SO impressed with people who get to that point of now longer being afraid, and who can attend all appointments with no sedation or help at all - and I think if you can reach that point, that's fantastic! What's key is that you must be allowed to set your own goals and make your own choices. If you believe in your dentist's plan - go for it! (And I apologise once more for my rather impassioned speech!) If you remain convinced that IV sedation is the best choice for you, then don't be afraid to ask for it! (If it's too late for Thursday, ask to cancel and rebook.) Unless you're sure it's what you want, please don't suffer through another ordeal of an appointment, when it doesn't have to be that way.

Fwiw, if you go with the diazepam, I think it's best to take it in the way your dentist has prescribed. Or, if you want to change when you take the tablets - especially if it's going to involve taking them closer in time together - ring up and check it's ok to do it that way first. With any medication, it's always better safe than sorry.

All the best for Thursday, and the anxious days in between!

 

[bella127]

Thank you for taking the time to write that reply

The clinic doesn't offer IV sedation as standard - they have to bring some other guy in to supervise. Whilst I would love IV sedation (even for a check up, that would be nice.. never gonna happen, but nice!), I really do want to try and get as "normal" as I can with as little faff as possible. If I spend the rest of my life having to pop a few pills before heading to the dentist, then so be it - that's immeasurably preferable to never having to go again ever.

The dentist is lovely and is trying her best for me, and she does listen - I am keen to try and get going on this. I just wanted to give the diazepam the best possible chance of helping, as I felt the dosage last time was a bit all over the place and I don't know if I took it at the rigth times to be effective.

I know there's a root canal in my future somewhere, and we've already agreed that that can be done under IV as there's just no way on God's green earth I could get through that without it

 

[Gordon]

Diazepam is really not a very good drug for oral premedication, could you ask for a referral to a clinic that does offer IV sedation or at least a better choice of drugs?

 

[Patti]

My dentist prescribed 2.5mg of Ativan. That stuff wipes out anxiety!

 

[sudzs]

I was told by a dentist a couple of years ago that he couldn't prescribe valium for me. (in the UK btw) Something to do with Harold Shipman he said.

I have my own anyway!!! So I took 5mg today 90 mins before my appointment today and was fine until I was in the chair. Then the panic set in but then I wasn't 100% confidant in this dentist, only went back as I'd already paid forthe initial appointment, x-rays etc, and the previous filling she did had to be tweaked...... that was a weird one but might need a new thread.

But bella, that is a good dose you took, it would have zonked me out. For optimum effect though I would take the 30mg 90mins before the appointment but I'm no doc! That is a lot of diaz to take and if you still felt terrible then I'd take Gordons advice and seek other options.

 

[littlestar88]

sudzs Maybe you should see a different doctor if that one won't prescribe valium because of Harold Shipman. (Not really sure how he's relavent anyway). If theres nothing medically wrong with you and you arn't taking other medicines that would make valium a bad idea then a doctor should prescribe it to you. I got (a fairly weak) form of valium from my NHS doctor when I lived in the UK both for dental visits and air travel so there are certainly doctors out there who are willing to prescribe it. Good luck

 

[bella127]

My doctor refused Valium for me too, before I booked the dentist appointment - I felt like I needed something to even get anywhere near the clinic. But the doctor, and I quote, "won't prescribe drugs like that for minor problems like being bit nervous of the dentist".

Won't be seeing THAT joker again.

Thank you for all your considerations. I'm going to take it at about 9.50am I think, and I will talk to her today about other options if it still feels inadequate. I think my brain's just very, very good at blocking out anything that might help me when I get panicky - I've had to have tons and tons of local before because I was CONVINCED it was still agonising.

Ugh. I don't want to play

 

[littlestar88]

Makes me really cross to hear of doctors who wont provide medications to people who need them and also who describe phobias as 'minor problems'. Sounds like a good idea to find a doctor who actually understands. Also perhaps my doctor was a bit more willing with me because he had seen me faint every time they took blood so could see how bad I was!

 

[Kim]

I am with you on that one Littlestar88 - the doctor I saw before I got my treatment did prescribe me Diazepam tablets, and I had gone to her because she was normally really considerate. However, when I told her what it was for, she didn't seem at all sympathetic and told me I would be better to go for CBT, but that I would not be able to get that in time for my appointment, so I feel she rather reluctantly prescribed them.

I have taken them a couple of times, but hadn't really noticed much difference. When I had my extractions, Lincoln prescribed me Temazepam and I took one the night before and two the morning of - I really felt they put me into a sort of 'slow motion' state, and felt really chilled out.

Gordon, if you catch up on this, you say that Diazepam is not a very good oral pre-medication, what would you suggest asking for in relation to a better 'choice of drugs' please?

And Pianimo - I couldn't agree with you more, you have said it exactly how it is for me,

 

[Gordon]

Temazepam like Lincoln gave you

Much better drug, onset is faster, which is good, it gives a much nicer sedation effect somehow and it's also much faster at wearing off, Diazepam is much longer acting and just doesn't seem to work as well.

 

[Kim]

Thank you for clarifying that Gordon, because as you say, the effect was a whole lot more different to the Diazepam, but I had put that down to the dosage that I had taken, I more or less thought they were one and the same thing

 

[letsconnect]

I've read that 30mg temazepam is roughly equivalent to 15mg diazepam (valium), though because they act a bit differently, it doesn't really make sense to compare them that way .